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Rachel Hall
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Rachel Hall, a practice pharmacist who manages chronic conditions Working
as an independent prescriber has restored Rachel Hall’s faith in
the pharmacy profession.
Five years ago, Ms Hall, now a clinical pharmacist at The Old School
Surgery in Fishponds, Bristol, was working as a community pharmacist
for a large multiple. “I was on the verge of leaving the profession.
I was extremely demoralised by the job and the profession and felt I
was not developing in my career as a pharmacist,” she says.
Instead
of leaving, she decided to cut back on her hours in the pharmacy, undertake
a clinical diploma and work half a day a week for the local primary care
trust as a practice pharmacist. She has not looked back since.
Ms Hall has spent the past 10 months consolidating her skills and building
on what she learnt during the independent prescribing conversion course.
She has gradually developed her role within the primary health care team
and now feels fully integrated:
“The number of referrals I receive
from other members of the team and the fact that my clinics are now always
fully booked is an encouraging sign. Patients are more than happy to
see me as an alternative to their GP.”
Choosing type 2 diabetes as her speciality has made it easier for Ms
Hall to expand into other areas, such as hypertension, chronic kidney
disease and coronary heart disease. “I find the area of diabetes
particularly interesting and rewarding, and have now been trained to
initiate insulin in type 2 diabetic patients who are uncontrolled on
oral medication,” she says.
Looking to next year, Ms Hall plans to continue with her chronic disease
clinics and is hoping to free some time from her other responsibilities,
including reauthorisation of repeat prescriptions, so that she can take
on more of the minor illness workload from the GPs.
She will also be involved in the training of future independent prescribers,
marking their portfolios for the University of Bath.
Ms Hall is adamant that prescribing is the way forward for pharmacists
wishing to take on extra responsibility to expand their roles and improve
patient care.
“Even though the independent prescribing course is hard work, the end
result is worth it. Being able to make clinical decisions, and to have
that autonomy, is very satisfying,” she says.
“Qualifying as an independent prescriber is just the first step. Building
on these skills and continuing the learning is essential to ensure
safe, competent practice and to enable expansion of the role,” she
adds.
Ms Hall hopes that many more GP practices will invest in the services
of a prescribing pharmacist, which she believes is an excellent way
to ensure cost-effective prescribing, improve access to patients and
relieve
some of the GP workload.
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Nicola Stoner
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Nicola Stoner, a hospital pharmacist who specialises in cancer care
By September next year (2008), all four senior members of Nicola Stoner’s
team will be trained as independent prescribers. Dr Stoner, consultant
cancer pharmacist at Churchill Hospital, Oxford Radcliffe Hospitals NHS
Trust, is then aiming to expand the service that the team provides to
the hospital’s cancer directorate.
“We are running a rolling programme of training so that as other
members of the team become experienced, they will also have the opportunity
to
train to become independent prescribers,” she says.
Dr Stoner explains that the team currently prescribe patients’ own
drugs and supportive therapies independently but that they prescribe
chemotherapy as supplementary prescribers. In the future, she hopes to
develop the service so that adjuvant chemotherapy and monoclonal antibodies
are prescribed independently.
However, she adds: “It is important
that we are able to offer a consistent service. I may feel competent
to prescribe chemotherapy but I have to ensure that my colleagues are
happy to do
so before I can take the service in that
direction.”
In the meantime, she plans to expand
the current model to other adjuvant chemotherapy clinics and to a newly
established haematology inpatient pre-assessment clinic.
Dr Stoner’s only regret in terms of becoming a prescriber is that
she did not do it earlier. “Being a prescriber has allowed me to
develop my skills professionally, and to maximise the use of my existing
skills,” she says.
For pharmacists who are considering training as non-medical prescribers,
Dr Stoner recommends that they make sure they have an area to practise
in once they are
qualified.
“It is satisfying to be able to use your skills to the maximum
in this new role. Pharmacists should ensure they have a baseline of knowledge
in the area where they are going to prescribe, and that they have the
support of the multidisciplinary team and managers,” she adds.
Dr Stoner believes that the secret to managing her heavy workload is
to prioritise patient care and staff needs equally. “That way I
have a happy team and happy patients,” she says.
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Paul Saxby
Beth Hird
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Beth Hird, a primary care trust pharmacist who runs an asthma clinic
Pharmacists need to think creatively to find a niche for pharmacist
prescribing, according to Beth Hird, a prescribing adviser at Nottinghamshire
County Teaching Primary Care Trust.
“There are many nurses already
prescribing in many areas. We, as pharmacists, need to find the relevant
clinical areas that are not already covered by nurses, or work out how
to work alongside other professions,” Mrs Hird remarks.
Since January 2007, when she became the first pharmacist in the UK to
qualify as an independent prescriber, Mrs Hird has gained confidence
in diagnosing
asthma in patients who attend her weekly clinic at a local surgery.
“The
past year, acting as an independent prescriber, has been an exciting
time. I took the natural step from supplementary to independent prescribing
within the asthma clinics that I run. Running the clinics has been a
challenge, mainly due to time constraints and other pressures within
my role,” she explains.
Mrs Hird is content with the specialty she has chosen since it is one
that she feels competent to work within. “However, time permitting,
I would have liked to have had the opportunity to expand into chronic
obstructive pulmonary disease. This is an area that causes many hospital
admissions and, hopefully, one where pharmacists could impact on care.”
Incorporating the independent prescriber qualification into undergraduate
courses is an idea that has been mooted but Mrs Hird believes that some
basic clinic experience is essential before becoming a prescriber. “It
really helped me to be able to decide to prescribe within a specific
area, which would be harder to do at degree level,” she argues.
Due to other work constraints, Mrs Hird does not have plans to develop
her prescribing role next year. However, she hopes that in the future,
with the development of
practice-based commissioning and the Department of Health push to move
services into primary care, there will be more opportunities for pharmacists
to work alongside other professions and make use of their prescribing
skills.
Mrs Hird recognises that a future professional body will play an important
role in supporting pharmacists as their roles expand. She argues that
any new professional body for pharmacy should represent all sectors.
“I
would like to see a future professional body that supports and actively
promotes the development of all pharmacists working across all areas
from industry, to hospital, through community pharmacy and primary care.”
Finding the right work-life balance is difficult in a high-pressure job.
Mrs Hird has found that prioritising her workload is a necessary part
of her day-to-day role and she recommends the information mastery course
offered by the National Prescribing Centre. “It has certainly helped
me to prioritise my reading piles,” she declares.
Mrs Hird is happy with her chosen career and would encourage other pharmacists
to become independent prescribers: “Running a clinic and prescribing
is rewarding and really uses pharmacists’ knowledge and skills.”
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Mahesh Sodha
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Mahesh Sodha, a community pharmacist who runs weekly clinics
Few primary care trusts are willing to fund community pharmacists as
independent prescribers, says Mahesh Sodha, a community pharmacist in
Essex who runs weekly clinics at a local GP practice.
“Although many of my colleagues admire the concept of independent
pharmacist prescribing they are, quite rightly, sceptical about who is
going to
pay for these services. The Government has made this a local PCT issue
and few are willing to fund community pharmacists in this role,” he
explains. He adds that, in his experience, PCTs are happy to pay PCT
prescribing pharmacists to carry out the same role.
On a more positive note, Mr Sodha explains that he now feels very much
a part of the team at the practice where he runs clinics for patients
with type 2 diabetes, hypertension, dyslipidaemia and chronic renal disease.
“I shall be starting an accredited course in management of erectile
dysfunction in the New Year as well as one in sexual health, since this
is a priority
for the local PCT,” he says. He also hopes to start prescribing
for patients with chronic pain, an area in which he believes he has sufficient
expertise.
Mr Sodha has few regrets about the way he has approached the past year.
However, given the time again, he would have liked to undertake a course
in diagnostic skills. “The only trouble is that most of these courses
are aimed at the nursing profession only,” he
argues.
He would also advise community pharmacists who are thinking of training
as independent prescribers to take a further course to improve their
clinical skills. Mr Sodha believes that post-registration experience
is essential for pharmacists to gain the consultation and clinical decision-making
skills required to be an independent
prescriber.
Mr Sodha hopes that any future professional body for pharmacy will have
an
important role in accrediting specialist pharmacists. “Membership
of the new body ought to be an endorsement of the competency of a pharmacist
both as a generalist as well as a specialist. I would then expect employers
to be looking for this membership in their workforce as proof of competency
to practise as an advanced practitioner,” he says.
However, he is not in favour of technicians being part of the new body,
something he recognises may be a controversial stance to take. “Technicians
support pharmacists very well and should have their own body. While I
support doctors in their surgeries, it does not entitle me to become
a member of the Royal College of General Practitioners, even if I were
to pass their examinations,” he points out.
In five years’ time, Mr Sodha plans to semi-retire. “That
is to sell up my business and to teach at a university part time and
treat patients part time,” he explains.
Discussion
forum
The Royal Pharmaceutical Society hosts a discussion forum
for pharmacist prescribers.
To apply to become a member
e-mail
supplementary.prescribers@rpsgb.org
providing your registration number.
Membership is open to
supplementary and independent prescribers, and pharmacists
undertaking prescribing
courses accredited by the Society. |
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The
Pharmaceutical Journal